Provider Demographics
NPI:1497902308
Name:GOODWIN, KAREN M (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3100 SAN PABLO AVE STE 430
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2498
Mailing Address - Country:US
Mailing Address - Phone:415-476-3366
Mailing Address - Fax:510-985-5202
Practice Address - Street 1:3100 SAN PABLO AVE STE 430
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2498
Practice Address - Country:US
Practice Address - Phone:415-476-3366
Practice Address - Fax:510-985-5202
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2020-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A13431208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA122365Medicare PIN